Greenish aspirate in a case of lower GI bleeding as mentioned in Kaplan notes - USMLE Forums
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Old 06-13-2010
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Listening Greenish aspirate in a case of lower GI bleeding as mentioned in Kaplan notes

So as am reading the surgery book of Kaplan notes I noticed that they mentioned something like this
"if you have a greenish aspirate from the NG tube then the whole upper gastrointestinal tract has been excluded and there's no need to do upper endoscopy and we should then look for lower GI sources of the bleeding"

I could not understand this, can you please discuss with me :sorry:
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Old 06-13-2010
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Default Explanation

Well in a very simple way ,, presence of greenish aspirate means presence of bile. And bile refers to the second part of duodenum where the orifice of ampulla of Vater exists (duodenojejunal junction is the cut point between upper and lower GIT) . So here we have 2 situations:

1-If blood comes from an upper GI source then it will not go through the second part of the duodenum or the area below (because there's no chance for that to happen), then it will never be stained with bile as it's not supposed to be.

2-If blood comes from a lower GI source then it will definitely go through the second part of the duodenum and the area below in its way up to the oral cavity , then it will definitely be stained with bile as it's supposed to be.

Hope that was helpful
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Old 06-13-2010
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value of NG tube in GIT bleedin

1) upper Git source = above ligament of trietz ( structure devides dudenum from jejunum)
2)Lower GIT = beolw ligament of trietz

* The bile is poored in the dudenum so if blood come from area above duenum --> mix of blood+ bile --> blood in aspirate
* if lower GIt --> you aspirate the bile before it come down to mix with the blood
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